sábado, 14 de fevereiro de 2015

Leadership

This post is part of an occasional series focused on the
health care industry, where escalating costs are posing unprecedented
challenges, new models are upending longstanding ways of doing business
and the digital age is fueling a new era of innovation.

The challenges facing the health care industry threaten to spiral out
of control. The high and rising cost of health care; the convoluted,
disjointed medical care system; the massive and growing burden of
obesity, heart disease, diabetes and cancer; difficult ethical questions
about what constitutes appropriate care; incentives to provide more
care instead of better care. This potent mix of challenges keeps a lot
of very smart people awake at night. Sleep, by the way, is a pretty important aspect of good health and well being.

But there are rapidly expanding pockets of change, many of them,
where stakeholders are partnering to brainstorm, test and optimize
solutions. One of those is at Minneapolis-based HealthPartners Health
Plan, where such initiatives are growing under the guidance of Dr. Shaun
Frost. He works at what has historically been a sometimes difficult
point of interaction – between the doctors who provide care and the
insurers who pay for it. As a practicing physician himself, Frost walks
into meetings sharing common ground with other health care providers,
but more than common ground is needed to foster the innovation needed in
health care. The goal of these collaborations is to improve delivery of
care in three areas: health, patient experience and affordability, the so-called triple aim.

Dr. Shaun Frost

In the spirit of collaboration, Frost has shared his secrets to
building relationships across silos – even those with historically
complicated relationships – with his peers in the industry, and here.
Read on for Dr. Frost’s prescription for collaboration, which starts
with four tenets of leadership, followed by some of his guiding
principles for navigating the choppy waters of change.

Leadership lessons for collaborators

Differentiate adaptive from technical challenges: Any change
in an organization or system will bring about technical challenges,
which may be substantial but can be solved using current ways of
thinking. Examples might be adapting to a new type of technology or
opening a new retail interface. Adaptive challenges, though, are only
solved by creating entirely new ways of thinking with everyone affected
involved with developing the new mind-set. “We need to create completely
different ways of problem solving and different ways of thinking about
how to address these challenges,” Frost says. “Designing new problem
solving methodologies is usually more complex than solving the
surface-level problems themselves. It thus behooves those affected by
adaptive challenges to work collaboratively on the process of thinking
differently.” For example, Frost argues insurers alone should not design
and deploy value-based health care innovations. “They should be
produced collaboratively through joint input from everyone who has a key
interest in payment reform.”

Create empathy through generative dialogue: This tenet is
key as distinct parties who may have had difficult relationships in the
past lay the groundwork for collaboration. Frost also calls it
“listening from outside ourselves, while simultaneously listening from
inside the perspective of others.” Basically, you have to recognize that
all perspectives are relevant, and everyone brings their own context to
a problem, a dataset, a brainstorm. “True collaboration is facilitated
by the degree to which we are able to genuinely understand the
perspectives of others, and how those perspectives influence the
environment in which we collectively operate,” Frost says. “This results
from generative dialogue during which people honestly listen so as to
appreciate the validity of viewpoints that may be different from their
own.”

Shared accountability: In health care, recognizing that
everyone interacting with a patient bears responsibility for outcomes is
what Frost calls “the glue that pulls it all together” and the tool
that cuts out blame and an us-vs.-them mentality when partners are
developing health care collaborations. One way this looks is shared
financial gains when goals under new models are achieved, and shared
losses when they aren’t, rather than one party assuming all the risk.

Compete on execution vs. innovation: This is a principle
Frost acknowledges isn’t right for all industries. But in health care
and other sectors built around an altruistic goal, he argues it’s
important to consider. Frost works on developing value-based (versus
volume-driven) reimbursement models for delivering health care, an area
where many insurers, providers and other organizations are testing a
variety of approaches. He explains how “we need to recognize that by
changing from a pay for volume to a pay for value system, those people
who possess the tools that generate value will have an economic
competitive advantage. If those tools are viewed as intellectual
business capital, they may not be shared freely with others in the
community – which would ultimately retard progress towards enhancing
value for all.” He argues health care stakeholders should agree to
compete on the implementation and execution of new tools, instead of
competing on the possession of the tools themselves.

Stay on track while navigating change

Recognize major change is a marathon, not a sprint: Respect
the magnitude of challenges and set smaller milestones. As Frost’s
organization develops collaborations, they start with early adopters –
those most likely to be on board and achieve success – and they break
down goals by focusing on one piece of the triple aim, developing models
that initially include upside risk only (their partner benefits when
things go well but has nothing to lose if they don’t).

Stay flexible: Not every arrangement needs to look the same.
When HealthPartners develops metrics for success under new models of
care, they are menus that allow for solutions to be customized based on
the partner and the collaboration.

Data without context doesn’t do much: Health care, like many
industries, is heavily focused on collecting data and using it in a
meaningful way. Used optimally, health data could unlock life-saving
insights into how to treat disease and promote wellness in a cost
effective manner. But not all of HealthPartners’ collaborators are
prepared to handle analytics and act on insights from data. So,
HealthPartners provides resources to facilitate interpretation and
action.

Ensure fair process: What this means at HealthPartners is
everyone gets to speak their mind, through a variety of channels.
There’s input from all angles before decision making and again after.
Which sounds a lot like collaboration.

* Dr. Shaun Frost is associate medical director for care delivery
systems with HealthPartners Health Plan in Minneapolis. He is also a
practicing physician with Regions Hospital and a clinical assistant
professor of medicine at the University of Minnesota Medical School.

* Melissa Turner is an editor on SmartBrief's health care team, handling
briefs on policy, insurance, medicine and veterinary medicine. She's a
former newspaper writer and copy editor and is a trained wildlife
biologist with background in biotechnology.